Abstract

Although clinical trials have shown benefit from early rehabilitation within the ICU,
rehabilitation of patients following critical illness is increasingly acknowledged
as an area of clinical importance. However, despite recommendations from published
guidelines for rehabilitation to continue following hospital discharge, there is limited
evidence to underpin practice during this intermediate stage of recovery. Those patients
with ICU-acquired weakness on discharge from the ICU are most likely to benefit from
ongoing rehabilitation. Despite this, screening based on strength alone may fail to
account for the associated level of physical functioning, which may not correlate
with muscle strength, nor address non-physical complications of critical illness.
The aim of this review was to consider which patients are likely to require rehabilitation
following critical illness and to perform an integrative review of the available evidence
of content and nature of exercise rehabilitation programmes for survivors of critical
illness following hospital discharge. Literature databases and clinical trials registries
were searched using appropriate terms and groups of terms. Inclusion criteria specified
the reporting of rehabilitation programmes for patients following critical illness
post-hospital discharge. Ten items, including data from published studies and protocols
from trial registries, were included. Because of the variability in study methodology
and inadequate level of detail of reported exercise prescription, at present there
can be no clear recommendations for clinical practice from this review. As this area
of clinical practice remains in its relative infancy, further evidence is required
both to identify which patients are most likely to benefit and to determine the optimum
content and format of exercise rehabilitation programmes for patients following critical
illness post-hospital discharge.